Chimeric antigen receptor T cells for sustained remissions in leukemia.

TitleChimeric antigen receptor T cells for sustained remissions in leukemia.
Publication TypeJournal Article
Year of Publication2014
AuthorsMaude SL, Frey N, Shaw PA, Aplenc R, Barrett DM, Bunin NJ, Chew A, Gonzalez VE, Zheng Z, Lacey SF, Mahnke YD, Melenhorst JJ, Rheingold SR, Shen A, Teachey DT, Levine BL, June CH, Porter DL, Grupp SA
JournalN Engl J Med
Volume371
Issue16
Pagination1507-17
Date Published2014 Oct 16
ISSN1533-4406
KeywordsAdolescent, Adult, Antibodies, Monoclonal, Humanized, Antigens, CD19, Child, Child, Preschool, Chimera, Cytokines, Female, Genetic Engineering, Genetic Therapy, Genetic Vectors, Humans, Immunotherapy, Lentivirus, Male, Middle Aged, Precursor Cell Lymphoblastic Leukemia-Lymphoma, Receptors, Antigen, T-Cell, Recurrence, Remission Induction, Survival Rate, T-Lymphocytes, Young Adult
Abstract

BACKGROUND: Relapsed acute lymphoblastic leukemia (ALL) is difficult to treat despite the availability of aggressive therapies. Chimeric antigen receptor-modified T cells targeting CD19 may overcome many limitations of conventional therapies and induce remission in patients with refractory disease.

METHODS: We infused autologous T cells transduced with a CD19-directed chimeric antigen receptor (CTL019) lentiviral vector in patients with relapsed or refractory ALL at doses of 0.76×10(6) to 20.6×10(6) CTL019 cells per kilogram of body weight. Patients were monitored for a response, toxic effects, and the expansion and persistence of circulating CTL019 T cells.

RESULTS: A total of 30 children and adults received CTL019. Complete remission was achieved in 27 patients (90%), including 2 patients with blinatumomab-refractory disease and 15 who had undergone stem-cell transplantation. CTL019 cells proliferated in vivo and were detectable in the blood, bone marrow, and cerebrospinal fluid of patients who had a response. Sustained remission was achieved with a 6-month event-free survival rate of 67% (95% confidence interval [CI], 51 to 88) and an overall survival rate of 78% (95% CI, 65 to 95). At 6 months, the probability that a patient would have persistence of CTL019 was 68% (95% CI, 50 to 92) and the probability that a patient would have relapse-free B-cell aplasia was 73% (95% CI, 57 to 94). All the patients had the cytokine-release syndrome. Severe cytokine-release syndrome, which developed in 27% of the patients, was associated with a higher disease burden before infusion and was effectively treated with the anti-interleukin-6 receptor antibody tocilizumab.

CONCLUSIONS: Chimeric antigen receptor-modified T-cell therapy against CD19 was effective in treating relapsed and refractory ALL. CTL019 was associated with a high remission rate, even among patients for whom stem-cell transplantation had failed, and durable remissions up to 24 months were observed. (Funded by Novartis and others; CART19 ClinicalTrials.gov numbers, NCT01626495 and NCT01029366.).

DOI10.1056/NEJMoa1407222
Alternate JournalN. Engl. J. Med.
PubMed ID25317870
PubMed Central IDPMC4267531
Grant List1R01CA165206 / CA / NCI NIH HHS / United States
P30 AI045008 / AI / NIAID NIH HHS / United States
P30 CA016520 / CA / NCI NIH HHS / United States
P30 CA147859 / CA / NCI NIH HHS / United States
R01 CA116660 / CA / NCI NIH HHS / United States
R01 CA165206 / CA / NCI NIH HHS / United States
R01CA102646 / CA / NCI NIH HHS / United States
R01CA116660 / CA / NCI NIH HHS / United States